The Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program works with countries to adopt new medicines and regimens, such as bedaquiline for MDR-TB, using a systems strengthening approach that engages stakeholders, builds on existing systems or establishes new ones where appropriate, strengthens human resources via trainings, improves the distribution chain for new TB medicines, and records and reports information for decision making in relevant areas.

SIAPS promotes stewardship and pharmaceutical governance by working with national TB programs (NTPs) to coordinate all in-country partners and define roles and responsibilities for the programmatic implementation of these new medicines and regimens. The intent is to prevent parallel systems and duplication of efforts in resource-limited settings. The overall goal is to introduce new TB medicines and regimens in a sustainable way that builds on the country’s strengths and fortifies its areas of weakness.

To date, SIAPS has successfully worked with NTPs in several countries to introduce bedaquiline, update MDR-TB guidelines, and build the capacity of clinicians to manage patients on new medicines. In Uganda, for example, 12 patients have received treatment with bedaquiline and 124 health care workers have been trained on how to manage patients on bedaquiline, delamanid, and the nine-month regimen. To improve patient safety, SIAPS has also worked with the Swaziland NTP by providing technical assistance in the introduction of new TB medicines as well as active surveillance of adverse events through the National Pharmacovigilance Unit, which is a required component of new TB medicine use. As of January 2017, 93 people have been or are currently on bedaquiline treatment. In the Philippines, SIAPS supported the NTP to introduce bedaquiline, and 68 patients have enrolled in treatment to date. Georgia, the first country that SIAPS worked with to introduce bedaquiline, had enrolled 246 patients as of December 2016.

SIAPS’ successes in increasing the uptake of new tools, including bedaquiline, in the fight against TB has addressed the common challenges of a lack of expertise, infrastructure, and appropriate systems to monitor the efficacy, safety, and potential adverse effects of these medicines to strengthen health systems.